The symptoms of atrial fibrillation aren’t always clear. That's dangerous because the condition, in which your heart beats too fast or slow, can lead to a stroke or death if not treated. Read on for expert answers about life-saving treatments…

Does your heart go pitter-patter rather than the normal lub-a-dub-dub? You could be among the 2.5 million Americans who have a heart rhythm abnormality known as atrial fibrillation (AF or AFib, for short).

“Many patients say it feels like palpitations in their chest or an uncomfortable heartbeat, and some complain of shortness of breath,” says heart rhythm abnormality expert Daniel P. Morin, M.D., director of electrophysiology research at the Ochsner Center in New Orleans.

Aside from that, there often are no detectable signs of atrial fibrillation, he says.

But an irregular heartbeat needs to be treated because “atrial fibrillation can increase your risk of stroke,” Dr. Morin says.

Read on as he answers common questions about AF.

Why does atrial fibrillation happen? When the heart beats normally, electrical impulses cause the top part of the heart, or the atrium, to contract first, and then the bottom part contracts. That’s what gives us the normal heartbeat sound. But with atrial fibrillation, there’s a chaotic quivering in the heart’s top chamber, so the heart doesn’t beat [normally].

What kind of problems does this pose?
There are three problems with this kind of irregular heartbeat. The first is that it often makes you feel very bad. Sometimes people don’t have any symptoms. But many people are out of breath, lightheaded and don’t have any energy.

The second problem is that when the top chamber beats chaotically, it can make the bottom chamber go too fast, which can cause your heart to wear out.

And finally, AFib can cause your blood to pool and form clots in the heart, and these clots can travel to other parts of the body such as the kidneys or liver. The worst thing that could happen is that the clot goes to your head, which causes a stroke.

Why do people get AFib? That’s the billion-dollar question. This is an area of intense research all around the world. We know there are certain risk factors, with age being the biggest one.

How does age increase the risk of an irregular heartbeat?
As we age, certain parts of our bodies – including the heart – become more [fibrous], making irregular heartbeats more likely.

In addition, many risk factors that increase the likelihood of AFib occurring, such as diabetes and high blood pressure, are more common in older people.

How is atrial fibrillation diagnosed?
Patients sometimes see their doctors because of palpitations and other heart rhythm symptoms. But lots of times, people just go in for their regular checkup, and the doctor detects an abnormally fast or irregular heartbeat. An EKG can confirm the diagnosis.

Are there different types of AFib? There are three categories: paroxysmal, persistent and permanent.

With paroxysmal AFib, you’re in AFib for only a short period and come out of it on your own.

With persistent AFib, treatment, such as medication, is necessary to get you out of it.

With permanent AFib, your episodes continue, no matter what we do.

AFib usually progresses from paroxysmal to persistent to permanent. We say, “AFib begets AFib,” because the more you are in it, the more you get it.

Does the type of AFib increase the risk of stroke?
Regardless of what category you’re in, the risk of stroke is exactly the same. That’s why patients in all three of these categories may be treated with anticoagulant drugs, or blood thinners, even if they only get AFib once in awhile.

Do all people with atrial fibrillation need to take a blood thinner to lower their risk of stroke? Not necessarily. We decide if someone is a candidate for an anticoagulant medication by looking at his or her other risk factors for stroke. We recommend either aspirin or the prescription drug [warfarin] for patients who have at least one of the following risk factors: congestive heart failure, high blood pressure, age greater than 75, diabetes or prior stroke. If patients have two or more of these risk factors, we recommend [warfarin].

How is an irregular heartbeat treated?
We have two treatment routes, and our choice of treatment depends on whether a patient has symptoms such as palpitations and shortness of breath.

If there are no symptoms, we usually try to adopt a rate control strategy. That means that we don't try hard to keep people in normal rhythm as long as their heart rate is well controlled, which we do with medications such as beta blockers and calcium channel blockers.

If someone has symptoms, then we use a rhythm control strategy using an anti-arrhythmic drug.

Are there any risks involved with taking anti-arrhythmic drugs? Yes, the most serious one is that patients can sometimes develop a more serious heart rhythm abnormality called ventricular tachycardia, which puts you at risk for sudden cardiac arrest.

In addition, some drugs when taken over a long period can cause significant thyroid problems.

What happens if medications don’t work?
Medications in general work 50% or 60% of the time. So if medication doesn’t work, we usually recommend either surgery or a procedure known as catheter ablation.

What do these procedures do?
With catheter ablation, we run small wires from the veins at top of the legs up to the heart, so we can electrically isolate the trigger that’s causing the beginning of AFib to occur and prevent it from happening. During the procedure, the patient is given either general anesthesia or conscious sedation.

With surgery, the doctor uses a scalpel to draw a maze inside the left upper chamber of the heart, which isolates the trigger of AFib from the rest of the atrium.

What are the risks of catheter ablation?Although the complication rate with ablation is getting lower, major complications can occur, especially bleeding. That is why we generally require patients to try at least one anti-arrhythmic drug before choosing catheter ablation.

The risk of complication goes up the older you get, because the walls of the heart become thinner and so tears can occur, especially in smaller people. When bleeding occurs, we have to stop the procedure so we can drain the blood that pools outside the heart.

And what are the risks with surgery?
When the procedure is done surgically, the doctor usually has to open up the patient’s chest, which means a slower recovery time and more chance of surgical complications.

Does ablation cure AF?
That’s the target, but it may not eliminate AFib. Studies show that after one ablation, the success rate is 70%-80%, so 20%-30% of patients require a second procedure. After two procedures over the course of the year, the success rate goes up to 90%.

What conditions increase the risk of developing AFib? Diabetes, high blood pressure, congestive heart failure and thyroid disease. A prior stroke also raises your risk. Finally, sleep apnea, which happens more frequently in obese people, is another risk factor. We think it’s because when you stop breathing while you’re sleeping, it changes your heart’s electrical system.

Is a person with an irregular heartbeat at greater risk for other heart conditions, such as congestive heart failure?
AFib doesn’t necessarily cause an increase in other kinds of heart problems, but it runs in the same circles. So if you have it, you’re more likely to have other heart issues such as high blood pressure.

Are angina and atrial fibrillation related? No. Angina is a type of chest pain that comes with exertion, usually caused by blockages in the arteries. AFib is the result of changes in the heart’s electrical system.

So one’s a plumbing problem and the other is an electrical problem. They’re two separate systems, although some people have both problems.

Is AF genetic?
Emerging evidence indicates that there may be a genetic component. An AFib gene hasn’t been discovered, but we think certain genes may increase your risk for developing the disorder.

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